Isoechoic axillary lymph node metastases of mucinous carcinoma of the Breast: A case report

We report a case of isoechoic axillary lymph node metastasis of mucinous carcinoma (so-called pure mucinous carcinoma) of the breast. A 47-year-old premenopausal woman was referred to our hospital with a 2 years history of mass and distortion of her left breast and with recent worsening of her symptoms. Ultrasonography demonstrated a well-circumscribed mass, about 5 cm in diameter, which was isoechoic compared to the surrounding fat tissue. Distal enhancement was also recognized. A left axillary ultrasonographic scan demonstrated four nodules, which were indistinct because of their isoechogenicity compared to the surrounding tissue. Based on a preoperative diagnosis of mucinous carcinoma of the left breast with left axillary lymph nodes metastases, left mastectomy and left axillary nodal dissection were performed. Mucinous carcinoma with axillary lymph node metastases was diagnosed histologically. The lymph node metastases showed histological findings identical to those of the primary tumor, which was considered to be the reason for their isoechogenicity. Although lymph node metastasis of mucinous carcinoma of the breast is rare, ultrasonographers should perform careful scanning when the primary breast mass is suspicious for mucinous carcinoma, because lymph node metastases of mucinous carcinoma can be more indistinct and difficult to detect than those of other types of breast cancer.     

Primary osteosarcoma of the breast

We report a case of primary osteosarcoma of the breast, which is a rare histological type of all breast tumors. A 58-year-old woman had noticed a right breast mass long before presenting to our hospital because it had gradually increased in size. The mass was bony-hard, 90 x 70 mm in size, and was located mainly in the upper outer quadrant of the left breast. Mammography demonstrated a round radiopaque mass with a shaggy outline. There were small bone metastases to the pelvis and scapula on bone radionuclide scan, but no other metastasis was observed with subsequent investigations. Modified radical mastectomy including axillary lymph node dissection was performed. Histologically, the excised tumor was consistent with extraskeletal osteosarcoma of the breast accompanied by lymph node metastses. In spite of adjuvant chemotherapy, the patient suffered a local recurrence four months later and died of aggressive multiple metastases 7 months after surgery.     

Accessory breast tissue in axilla masquerading as breast cancer recurrence

Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.     

A case of ectopic breast cancer with a literature review

A 63-year-old woman was referred to our hospital because of a right axillary nodule in 2004. Physical examination showed a spherical nodule measuring 0.5 cm in diameter in the right axilla. No mass was palpable in either breast. Mammograms were normal. Ultrasonography revealed a subcutaneous hypoechoic mass 0.7 mm in maximum diameter in the right axilla. The patient underwent an excisional biopsy. Histological examination revealed an invasive ductal carcinoma (scirrhous carcinoma) in ectopic breast tissue. The patient subsequently underwent a wide local excision of the tissue surrounding the biopsy scar, with axillary lymph node dissection. Histologically, no residual tumor or nodal metastasis was found. Postoperatively, she received endocrine therapy and remains well, without any evidence of recurrence 4 years 10 months after operation. Cancer of the ectopic breast tissue is rare, and most cases present as a solitary axillary mass. Long-term outcomes remain unclear. We present a case of breast carcinoma in the axillary ectopic mammary gland and summarize the clinical features of 94 cases, including ours, in Japan. We also compare long-term survival between ectopic breast cancer and usual breast cancer according to TNM T stage and lymph node metastasis.     

Magnetic resonance findings in women at high risk for developing breast cancer: an Australian feasibility study

In younger women at high risk for developing breast cancer the value of mammography is limited by a higher prevalence of breast tissue density, low rate of DCIS in gene carriers, faster growing tumours and concerns over radiation exposure. We report on our experience of MR screening in high risk patients over a three year period. Women at high risk of developing breast cancer were offered an MRI scan and an Ultrasound in addition to their annual mammogram for two years. The following MR-protocol was used: pre-contrast T2 STIR sequence and pre contrast 3D FLASH sequence, post contrast axial dynamic 3D FLASH sequence. Seventy two women consented to participate in this study. One hundred thirty nine breast MRI examinations were performed. Two pre-cancerous lesions and an axillary lymph node metastasis were found, but the majority of the lesions were benign. Difficulties in screening young women at high risk are discussed in this paper. In our study three lesions of significance were detected. Two lesions were precancerous thus curable. The recall rates show the difficult nature of screening younger breasts. MRI generated more findings judged as uncertain, so short term-term follow up studies or MR-guided biopsy techniques are required.     

Role of dynamic magnetic resonance imaging in the evaluation of tumor response to preoperative concurrent radiochemotherapy for large breast cancers: a prospective phase II study

PURPOSE: To evaluate the accuracy of clinical examination and of three imaging modalities (ultrasound [US] scan, mammography, and magnetic resonance imaging [MRI]) to assess the tumor response of breast cancer to a preoperative regimen of concurrent radiochemotherapy for large breast cancers, using pathologic data as the reference. METHODS AND MATERIALS: Sixty women were accrued. Treatment consisted of 4 cycles of (5-fluorouracil-vinorelbine) chemotherapy with, starting with the second cycle of chemotherapy, locoregional radiotherapy to the breast and the internal mammary and supraclavicular and infraclavicular lymph nodes. Breast surgery and axillary lymph node dissection were subsequently performed. Breast imaging assessments were performed both before chemotherapy and preoperatively. RESULTS: The correlation coefficients between tumor dimension at imaging and pathology were statistically significant for US scan (r = 0.4; p = 0.006) and MRI (r = 0.4; p = 0.004) but not for clinical examination (r = 0.2; p = 0.16) or mammography (r = -0.15; p = 0.31). Furthermore, the area under the receiver operating characteristic curve for MRI was 0.81, compared with 0.67 for US scan. At the optimal threshold score, MRI performed with 81% sensitivity and 75% specificity. CONCLUSION: Compared with clinical examination, US scan, or mammography, MRI substantially improved the prediction of pathologic tumor response to preoperative concurrent radiochemotherapy for large breast cancers.     

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sjögren's Syndrome: A Case Report

Sj?gren's syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.     

Phyllodes tumor arising in ectopic breast tissue of the axilla

We examined a 31-year-old woman with a solid mass in her left axilla. Physical examination and ultrasonography confirmed a 2 cm well-defined mass. Fine needle aspiration biopsy suggested fibroadenoma of breast. Excisional biopsy revealed benign phyllodes tumor of the ectopic breast tissue. Phyllodes tumor in ectopic breast tissue is an extremely rare occurrence. Only nine cases have been reported, including tumors of the vulva, inguinal region and axilla. This is the second case in the axillary region.     

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sj?gren's Syndrome: A Case Report

Sjögren''s syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.     

Non-invasive lobular carcinoma within a fibroadenoma, a preoperatively diagnosed case

Breast cancer within a fibroadenoma is rare and usually diagnosed postoperatively from pathological specimens. This paper reports a 54-year-old female with non-invasive carcinoma within a fibroadenoma, diagnosed preoperatively. She underwent a medical examination and mastopathy was suspected. On physical examination a mass 2 cm in diameter was palpated in the left breast. Ultrasonography showed a mass with smooth margins and uniform internal echoes, but cytology showed malignancy. Mammography showed a round mass with distinct margins and no calcification. As fibroadenoma, diagnosed by ultrasonography and mammography, and breast cancer, diagnosed by cytology, were not consistent results several core biopsies were performed. Needle biopsy showed proliferation of atypical epithelial cells; breast cancer within a fibroadenoma was diagnosed. MRI showed a circular mass with distinct, smooth margins and in a dynamic study, the mass showed irregular staining and the presence of early staining. Left lumpectomy and dissection of the left axillary lymph nodes was performed. Histological examination showed non-invasive lobular carcinoma occurring within a fibroadenoma.     

Magnetic resonance axillography for preoperative diagnosis of the axillopectoral muscle (langer’s axillary arch): a case report

The axillary arch of Langer is the most common muscular variation in the axilla. Recognition of anatomic variations is important for surgeons to perform safe axillary surgery. We describe a case of a woman with breast cancer, in whom sentinel lymph node biopsy was successfully performed and the presence of this anomaly preoperatively diagnosed by magnetic resonance axillography.     

隐匿性乳腺癌36例诊治分析

回顾分析临沂市肿瘤医院乳腺外科收治的36例隐匿性乳腺癌(OBC)患者的临床资料,并结合文献进行讨论。所有病例腋下肿物均经切检病理确诊。乳腺钼靶检查2例诊断为乳腺癌,3例患者为可疑乳腺癌;乳房彩超检查1例诊为乳腺癌,3例患者为可疑乳腺癌。行改良根治术28例,乳腺癌根治术4例,保留乳房手术2例,腋窝淋巴结清除加全乳放疗2例。30例患者获得随访,15例生存时间>5年。回顾分析结果提示,对腋下肿块应行切除活检以明确诊断;乳腺钼靶、彩超及腋下肿物激素受体检测有一定价值;乳腺核磁共振扫描能够提高OBC的检出率。手术方式宜采用改良根治术或保留乳房后全乳照射,并辅以化疗及内分泌治疗等以提高长期生存率。     

Axillary mass suspected to be occult breast carcinoma: a case study of skipped axillary lymph node metastasis from endometrial carcinoma in which core-needle biopsy was useful for diagnosis

A 55-year-old Japanese woman presented with metrorrhagia and was diagnosed with endometrial carcinoma. Chest computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) showed a left axillary mass. Regarding the diagnosis of the axillary mass, lymph node metastasis from the uterus was first suspected. Metastasis from the breast, lung, thyroid or stomach was considered next. On a general search including positron emission tomography (PET)-CT, there was no abnormality except endometrial carcinoma and the left axillary mass. Skipped axillary lymph node metastasis of endometrial carcinoma is extremely rare, with a reported incidence of 0.03% of endometrial carcinoma cases. The differential diagnosis was double carcinoma of the uterus and breast. We carried out US-guided core needle biopsy (CNB) of the axillary mass, and the histopathological findings suggested axillary lymph node metastasis from endometrioid carcinoma. US-guided CNB is a valid method for accurate diagnosis of an axillary mass.     

Axillary metastasis as first symptom of occult breast cancer: a case report

Axillary lymph node metastasis from an occult breast carcinoma is a rare occurrence. We report this condition in a 59-year-old woman who presented with a swelling in the right axilla. No breast mass was clinically evident. Mammography, ultrasonography and multiple random fine-needle breast biopsies yielded no pathological findings. No extramammary primary lesions were present. Axillary sampling was performed and histological examination revealed the presence of metastatic adenocarcinoma in three of the 12 dissected lymph nodes. Estrogen receptors were positive and immunohistochemistry pointed to a breast origin. All these data were suggestive of occult breast cancer. The patient refused any further treatment but accepted clinical and radiological follow-up. Eight years later mammography revealed in the same breast a 10-mm nodule containing microcalcifications, which was not evident at physical examination. The patient underwent a lumpectomy. Intraoperative histology was positive for breast carcinoma and complete axillary clearance was performed. Histological examination revealed a lobular invasive breast carcinoma and the presence of micrometastasis in one of the 23 removed lymph nodes. The patient was given radiotherapy to the breast and axilla and tamoxifen. At present, one year after the appearance of the primary tumor, she is free of disease. Based on this case report we suggest an eclectic approach in the management of patients with axillary metastasis from occult breast cancer, depending on the clinical, pathological and biological findings.     

Bilateral ductal carcinoma in situ (DCIS) in a male breast: A case report

Objectives: This case is presented to emphasize the importance of recognizing nipple discharge as a clinical sign of male ductal carcinoma in situ and an opportunity for early diagnosis. Clinical presentation and intervention: A 68-years old gentleman presented with bilateral bloody nipple discharge. Clinical examination of breasts showed no masses in either breasts and no axillary lymphadenopathy. He was investigated with bilateral mammogram, ultrasound scan and magnetic resonance imaging of the breasts. All were leading to a diagnosis of intraductal papilloma on the left retroareolar region and suspicious microcalcifications on the right retroareolar area. Retroareolar excision under general anesthesia confirmed the presence of DCIS in both specimens. Completion mastectomy was performed which showed no residual disease in either breasts. Conclusion: DCIS in male breast is very rare and hard to diagnose due to male breast morphology. It is best treated with mastectomy without axillary dissection. Keywords: Ductal carcinoma in situ, DCIS, male breast cancer.     

肉瘤样恶性间皮瘤的CT与MRI表现

目的 探讨肉瘤样恶性间皮瘤的CT与MRI表现特征.方法 回顾性分析6例经病理证实的肉瘤样恶性间皮瘤的CT与MRI资料.5例发生在胸膜,1例发生在腹膜.所有病例均行CT平扫加增强扫描,1例行MRI平扫加增强扫描.结果 5例胸膜肉瘤样恶性间皮瘤全部发生在左胸,广泛不规则胸膜增厚、胸腔积液.其中,3例形成巨大软组织肿块,平扫密度不均,增强明显不均匀强化;1例伴纵隔多发淋巴结肿大.1例腹膜肉瘤样恶性间皮瘤表现为大量腹腔积液,腹膜不规则增厚,形成巨大软组织肿块,平扫密度不均,增强不均匀强化,腹腔、腹膜后多发淋巴结肿大.MRI表现为不规则软组织肿块,T1加权像(T1 weighted imaging,T1 WI)等低信号、T2抑脂高信号,扩散加权成像(diffusion wighted imaging,DWI)高信号,增强后呈明显不均匀强化.结论 CT与MRI表现能较准确显示肉瘤样恶性间皮瘤的病变特征,对定性诊断有一定的提示作用.     

Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review

Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration. Our case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management.     

Early breast cancer following treatment of myelodysplastic syndrome: Report of a case

A 45-year-old woman was admitted to our hospital complaining of a mass in her left breast. She had previously been diagnosed with myelodysplastic syndrome (MDS), a type of refractory anemia, based on bone marrow findings and chromosome analysis. She received a preoperative transfusion of fresh packed platelets and a recombinant human granulocyte colony-stimulating factor (rhG-CSF) injection. Left partial mastectomy and axillary lymph nodes dissection were performed to treat early breast cancer. Postoperatively, prophylactic radiotherapy of the residual breast and administration of medroxyprogesterone acetate (MPA) were performed because the tumor tissue was positive for progesterone receptors. She has remained clinically stable, with no evidence of recurrence, for more than three years to date. We report a rare case of breast cancer with MDS, treated with breast-conserving therapy. The strategy of pre- or postoperative platelet transfusion, rhG-CSF injections, and hormonal therapy (AAPA) appears to be suitable treatment for progesterone receptor (PgR)-positive breast cancer patients with AADS.     

Primary infiltrating ductal carcinoma arising in aberrant breast tissue of the axilla: a rare entity. Report of a case

A 52-year-old woman presented with a palpable nodule in the right axilla. Physical examination revealed a 2.5 x 2.5 cm, nontender, firm, brownish, and peripherally hyperemic mass with overlying skin retraction on the right anterior axillary fold. Bilateral mammogram was negative. Ultrasonography of the right axillary region showed a 1.8 x 1.1 cm, poorly defined hypoechoic mass with irregular margins and posterior acoustic shadowing. Fine-needle aspiration biopsy of the mass revealed malignant epithelial cells. The patient underwent a wide local excision of the right axillary lesion with en bloc axillary lymph node dissection. Histopathological examination revealed an infiltrating ductal carcinoma. Here we report this case of carcinoma originating from aberrant breast tissue in the axilla. It is suggested that subcutaneous lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma and treated appropriately.     

Pure mucinous carcinoma with axillary lymph node metastasis in a male breast

Pure mucinous carcinoma of the male breast is an extremely uncommon malignant breast neoplasm and usually occurs at advanced age. It is characterized by a higher degree of mucus production, a more benign behavior, a lower incidence of metastatic nodal involvement, and a subsequent higher survival rate. We describe such a case of a 59-year-old male, who displayed a gradually growing retroareolar tumor of the right breast. The tumor was well demarcated and had a soft consistency with a gelatinous appearance. Based on the preoperative clinical identification of right axillary lymphadenopathy, the patient eventually underwent right modified radical mastectomy and right axillary nodal dissection. Regarding histological findings, the neoplasm corresponded to a pure mucinous carcinoma with axillary lymph node metastasis. Although lymph node metastasis of pure mucinous carcinoma of the breast is rare, it is essential to perform careful clinical examination when the primary breast mass is suspicious for mucinous carcinoma, because the presence of axillary lymphadenopathy will subsequently define the proper choice of therapeutic strategy.